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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by g_g_g_unit on September 6, 2010, at 2:59:37
hey . . .
how are you? i just wanted to ask your advice on some stuff that's been going on with my therapist (sorry for the length), and also advance an apology about being so dismissive at first about the possibility of PD's being implicated in my case . . the first few sessions i've spent with her, and the time devoted to reflecting in between, have really begun to break through my dissociative cloud and a lot of really painful stuff that i'd been protecting myself from has started flooding back over the past couple of days.
i don't completely agree that psychoanalysis will help my OCD, and neither does my therapist - though luckily she's trained in both analysis and CBT/ERPR.
the problem is that i've been really pushing for her to recognize the obvious ADD traits i've shown all my life. she issued the standard questionnaire, though i failed to meet the criteria for ADHD by 1 point! (in retrospect, i overestimated my ability to remember appointment dates/times, which would've pushed me over the edge). she said she's still open to the possibility of my having it, and could refer me for a stimulant trial in the future . .
now the problem is that i've been reading up a lot on the PD's and the ones that make sense are Covert Narcissism (she's already diagnosed me with this), Histrionic, and also Schizoid/Avoidant . .
the Schizoid thing in particular is really distressing me, and i'm still torn between whether i'm more avoidant or SPD. sorry if this is a little disorganized, i'll just throw some stuff at ya ..
- i show a long history of being highly (rejection) sensitive, having difficulty with emotional confrontation, trying to suppress my emotions in an effort to avoid being hurt, etc. but i don't believe i have an innate desire to avoid people's company . . a lot of these traits emerged after i was deliberately (or perceived myself to be) betrayed and hurt by people.
-i'm sometimes oblivious to how my actions affect others, but once i find out how they do, i will feel guilt and distress and attempt to correct my behaviour.
-i have had friends who i would call close, but more insofar as i felt comfortable/safe in their company, and less based on deep emotional intimacy (though i don't know how to measure the depth of my sharing .. i am not averse to expressing pain for example). i become really possessive and jealous when very close friends enter romantic relationships.
-i really can't do without the company of others (and sometimes experience intense fears of abandonment), and can relate to the idea of fearing being alone, yet being uncomfortable around others. as a teenager, i would hate being home by myself and would often go read in cafes just to be around others. i longed to be accepted by others and belong and would tell myself i don't need people in defense, though all that anger disappeared once i made my first non-judgemental friends.
now the problem is that i've been complaining a lot about my cognitive problems, and in typical histrionic fashion, will tend to exaggerate or stereotype things in order to ensure i'm heard. most people see through this, but this psychologist has taken things a little out of context and has begun to become very concerned about psychosis/schizotypy and repeatedly been asking me about whether i experience hallucinations etc. she even turned on me last session and just started reality testing me out of nowhere which i found highly distressing, and which has compromised my trust for her.
as far as i'm concerned, a lot of what i've described to her can be accounted for by severe depression and possibly ADD. i guess my fear is that if i bring up the schizoid traits too early she might completely dismiss the ADD idea, which would suck, because i've been working so hard to get someone to recognize its presence. i would hate to get trapped in psychotherapy at the expense of being able to improve my day-to-day functioning (the loss of which is doing the most damage to ego).
what do you think i should do? is it possible that ADD could co-exist with schizoid traits and that i am not committing a disservice by temporarily withholding information from her in order to have the ADD attended to? or is it possible that the schizoid traits have been causing ADD symptoms (which just doesn't feel likely to me)? or even that the social meekness inherent to ADD could cause the schizoid-like issueS?
thanks!! and sorry for such a long post ..
Posted by g_g_g_unit on September 6, 2010, at 6:28:19
In reply to questions for violette, posted by g_g_g_unit on September 6, 2010, at 2:59:37
hmm, this is confusing - even some borderline stuff (esp. swinging between idealization and devaluation) makes sense, especially with regards to my fear of abandonment ...
like i say, there seems to be traces of everything, though i guess that's the case with everybody
the problem is that i will read all this stuff and sometimes try and bend my story to fit it, or use one single disorder as a lens through which to view my life, which gets me in trouble ... particularly when dealing with a 'diagnosis happy' shrink. or my memory of events will be faint, or i'll kind of lack the self-insight or willingness to embrace what's really there, because it doesn't fit the DSM ..
do you know what i'm talking about? i guess i should stop trying to self-diagnose, particularly because the stuff i read starts to blur in with the truth. maybe what i'm saying bespeaks more of some kind of identity instability
Posted by violette on September 6, 2010, at 23:12:26
In reply to questions for violette, posted by g_g_g_unit on September 6, 2010, at 2:59:37
Hey ggg,
I'm glad to help you out...i was pretty much where you are about a year ago...i so understand what you are going through and what you're saying in your second post.
It shouldn't matter whether or not you have axis I ADD to take a stimulant, imo. It's kind of odd this is such a big deal with your therapist-but i could understand if she is concerned about psychosis and different PA type therapists have different opinions about patients taking meds-but is she ok if you take ADs, but not a stimulant? I would be concerned if that is the case...
I started to get pseudo-psychosis only after being in PA therapy, and I had taken stimulants, it never made a difference as it only comes out during emotional affect states-and appeared whether or not i was taking the stimulant (don't take them any longer and this symptom hasn't changed). True psychosis would be a different story...
Disclosure-I would withhold the least amount of information possible..for your benefit...but don't force yourself if you are too scared...i think it's important to build trust/alliance first.
Anyway, my advice to you, to get yourself organized, to help you deal with your fears and to find out whether or not you have ADD:
1. determine your temperment/cognitive style- object relations; how you were as a young child and what defense mechanisms you used then
2. determine your self-state (1, 2, or 3 below); read self/ego psychology
3. determine your attachment style-read attachment theory
4. determine your current defense mechanisms-read general object relations-find out which one's differ from those you used as a child
5. make sure you have the right type of therapistps i just made all this up
Your cognitive problems and OCD anxiety could be related to any of the above...for example, see if your OCD anxiety is more related to attachment-does it come out related to relationships? (did it increase since you started seeing this therapist, for ex.?). if it has, your ADD can be a symptom of your attachment style. Or is it always there regardless of relationships? ADD symptoms can be related to all sorts of axis II, temperment/biological, or attachment...impulse control issues, attachment-related OCD anxiety, OCPD traits, Schitzotypal, or emotional dysregulation can be 'ADD', just some examples. Forgetting dates/times can be related to attachment fears/addressing distressing emotions or passive-agression (not being able to express anger outward). It still happens to me, and i usually link it back to something specific...
You don't sound schizoid at all, silly! Sounds like you have the traits of those of us who had narcissistic mothers...it's basically a disorganized attachment (though one can have stronger preference for avoidance etc); there really is no diagnosis that describes 'it' except c-ptsd (which says the patient usually presents with multiple PD traits)..but the common features of this attachment issue are all the things you described. And if you read object relations/psychoanalytic theory, there really is little about 'c-ptsd', so that dx is pretty useless..as with reading 'traits' of DSM diagnoses.which is why looking at 'PD traits' in object relations is useful..I understand what youre saying-in your 2nd posteveryone has some 'PD traits'; there's a range and some of those traits are actually healthy if used temporarily...attachment explains a lot, and looking at your defense mechanisms can be very helpful, comparing what you used as a child vs now can help you determine your temperment...
I found from reading and talking to others-that people with the set of symptoms you describe often had a narcissistic mother-and it's almost as if we were stamped out of cookie cutters...with some variations based on temperment...i can't say what your mom is/isn't like, but i always wondered if this is your issue too...as you sound so much like this 'subgroup' I found w/similar symptoms but do not have 'borderline'...anyway the primary traits associated with insecure attachments, disorganized type is esp. related to having N mothers...seem to be those listed below (can be conscious or unconscious..)Which are traits are associated with many of the PDsso that may explain some of your confusion.
-low self esteem
-fearfulness/intimacy avoidance
-sensitivity, i.e. criticism
-weak or unstable sense of self
-abandonment fears/intimacy avoidance
-dependency issues-emotional dysregulation (often can be in context with relationships/attachment figures, i.e. avoidance/numbness, ocd anxiety, GAD, amotivation, impulse, or other affect - or - if consistent pattern, could be more related to overall temperment)
The "i don't need people' defense is common with those with childhood trauma histories; i would only include that as part of a PD if it has been consistent, because if not, it may likely be due to attachment issues....
Aside from those who express as borderline/less ego strength (and might have to use DBT to manage symptoms) I don't think any other therapy 'works' for this aside from psychoanalytic therapy...is your therapist strongly PA? It seems she may have broke through your defenses, which is why this is surfacing...but then again, some of the stuff she said/is doing sounds odd..I would only consider a T be 'psychoanalytic' if they 1. went through a formal PA program (or at least most of it) 2. did their own analysis. Many Ts are eclectic these days, and that may benefit people, but if you have an attachment issue, i would not use a T who wasn't strongly analytic, and esp. not one who did not undergo their own analysis...and for attachment issues, experience is a must. If you do have 'axis I OCD', i agree the CBT could help.
There are so many views of 'narcissism' out there, with every new researcher trying to rewrite or reorganize iteventually, everyone will be a narcissistbut i don't think anyone who feels 'guilt' should get a dx of narcissist-whether covert or overt. often a child of a narcissistic mother adopts traits of 'co-narcissism' which often = histrionic..which only in some ways = covert narcissist..but there are many differences as many are fearful/sensitive/overly empathetic; many children become little parents to tend to the needs of the N parent-people pleasers (histrionic-dependent/appeasing type). Youll drive yourself crazy trying to explain yourself through the dx you were givenI found it to be much simpler for us laypeople to look at it this way:
1. narcissist = strong, consistent, false sense of self
2. histrionic = consistently weak sense of self
3. borderline = unstable, oscillating sense of self
So those are the 3 basic states of self I go byIf you think you are more #1, then reading about narcissism might be helpfulPeople with narcissistic mothers seem to be #2 or #3 though...also, narcissism whether covert or overt traits are very close to avoidant and OCPD traits..which often get mistaken for 'narcissism'all 3 = low self worth. And more men get dx narcissism; women, histrionic or borderline...
If you think you are #2 or #3, i'd totally ignore the covert narcissist dx....and also, depression is a symtpom of all 3....
I think your fear of schizoid is a symptom of your anxiety!!
I'm doing well, thanks. Much better that I am not obsessively reading about psychology anymore! Still distracting myself from fears, but my interest in reading about this stuff is way down..thanks to my therapist recently kicking me in the *ss...and you might be less interested too one day, once you are able to face all your fears.
These are all just my opinions, but i hope it helps in some way!! good luck!
Posted by violette on September 13, 2010, at 10:55:51
In reply to questions for violette, posted by g_g_g_unit on September 6, 2010, at 2:59:37
If that stuff is too confusing, here's a simpler view:
It integrates the attachment, self, object relations and is probably one of the best articles i've seen free/online outside of books.
There are basically 3 types of MI called 'personality organization':
1. Neurotic
2. Borderline
3. Psychotic(there are different theories about this-but this one makes it simpler to understand)...'Borderline personality organization' is used broadly to differentiate neurotic/psychotic with those who may have more complex self/attachment issues. This, and similar concepts, seem to be inclusive of histrionic, 'overt narcissistic'...and all the things here that go with an insecure or disorganized childhood attachment that i mentioned:
-low self esteem
-fearfulness/intimacy avoidance
-sensitivity, i.e. criticism
-weak or unstable sense of self
-abandonment fears/intimacy avoidance
-dependency issuesIf you have a borderline personality organization, your temperment may affect the expression of those traits (extroverted vs introverted, agressive vs passive) etc. Also, one could be a high-functioning borderline, or neurotic, but express as borderline only during times of excess social stressors.
Page 5 talks about the cognitive problems-and points to cognitive differences of ADD and borderline traits. But keep in mind, if you have a schitzotypal temperment for example, it would compound the cognitive problems associated with a BPO. Either way, i don't think it should matter where the symptoms 'come from' to be treated with ADD meds...and why you couldn't simply take that test over for clarification of that one point difference. Many of those tests are subjective anyway.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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